ISASS Policy Statement - Cervical Interbody

Singh, Kern; Qureshi, Sheeraz A.

doi:10.14444/1013

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…This is compounded in the context of multiple-level procedures, as synthetic cage use is billed per level of placement, whereas allograft use is billed just once per operation. 21 The total wRVU for a standard 3-level plated ACDF with PEEK implants is approximately 64.81, while the same procedure using structural allograft totals 52.21 wRVU. Virk et al found the cost of even a single-level ACDF with a PEEK cage to be significantly higher than an ACDF with allograft ($18,314 vs $12,539).…”

Section: Discussionmentioning

confidence: 99%

“…5,8 The use of synthetic cages results in increased billing costs per surgical level compared with allograft, which may drive graft selection. 21 A previous study at our institution retrospectively examined the incidence of radiographic pseudarthrosis in patients who underwent a 1-level ACDF with either a PEEK or structural allograft implant, 7 and found a 5-fold higher rate of pseudarthrosis with the use of PEEK devices as opposed to structural allograft in single-level ACDF. Here we report on the occurrence of pseudarthrosis of PEEK devices versus structural allograft in patients who underwent multilevel ACDF.…”

mentioning

confidence: 99%

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PEEK interbody devices for multilevel anterior cervical discectomy and fusion: association with more than 6-fold higher rates of pseudarthrosis compared to structural allograft

Teton

Cheaney

Obayashi

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVECommon interbody graft options for anterior cervical discectomy and fusion (ACDF) include allograft and polyetheretherketone (PEEK). PEEK has gained popularity due to its radiolucent properties and a modulus of elasticity similar to that of bone. PEEK devices also result in higher billing costs than allograft, which may drive selection. A previous study found a 5-fold higher rate of pseudarthrosis with the use of PEEK devices compared with structural allograft in single-level ACDF. Here the authors report on the occurrence of pseudarthrosis with PEEK devices versus structural allograft in patients who underwent multilevel ACDF.METHODSThe authors retrospectively reviewed 81 consecutive patients who underwent a multilevel ACDF and had radiographic follow-up for at least 1 year. Data were collected on age, sex, BMI, tobacco use, pseudarthrosis, and rate of reoperation for pseudarthrosis. Logistic regression was used for data analysis.RESULTSOf 81 patients, 35 had PEEK implants and 46 had structural allograft. There were no significant differences between age, sex, smoking status, or BMI in the 2 groups. There were 26/35 (74%) patients with PEEK implants who demonstrated radiographic evidence of pseudarthrosis, compared with 5/46 (11%) patients with structural allograft (p < 0.001, OR 22.2). Five patients (14%) with PEEK implants required reoperation for pseudarthrosis, compared with 0 patients with allograft (p = 0.013).CONCLUSIONSThis study reinforces previous findings on 1-level ACDF outcomes and suggests that the use of PEEK in multilevel ACDF results in statistically significantly higher rates of radiographic pseudarthrosis and need for revision surgery than allograft. Surgeons should consider these findings when determining graft options, and reimbursement policies should reflect these discrepancies.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

PEEK interbody devices for multilevel anterior cervical discectomy and fusion: association with more than 6-fold higher rates of pseudarthrosis compared to structural allograft

Teton

Cheaney

Obayashi

et al. 2020

Journal of Neurosurgery: Spine

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“…Cost was defined as the total sum of hospital, physician, and graft fees based on Current Procedural Terminology codes. The code designated for a PEEK interbody cage (22851) has a significantly higher reimbursement rate than that for a structural allograft (20931), 23 with a work relative value unit of 6.7 versus 1.8, respectively. As such, there was a significantly higher total cost for an ACDF with a PEEK cage (estimated total cost of $18,314) than for the same procedure in which an allograft cage was used (estimated total cost of $12,539).…”

Section: Discussionmentioning

confidence: 99%

“…28 The PEEK cage, in particular, has gained significant popularity due to its radiolucent properties and its elastic modulus, which is similar to that of bone. 4,8,12 Furthermore, the use of PEEK cages results in increased billing per surgical level compared to allograft, 23 which may further drive graft selection. Of note, for single-level cases, if a PEEK cage is used without a plate, the number of work relative value units is fewer than if a structural allograft is used with a plate (approximately 36 vs 49, depending on the payor).…”

Section: J Neurosurg Spine Volume 30 • January 2019mentioning

confidence: 99%

Fivefold higher rate of pseudarthrosis with polyetheretherketone interbody device than with structural allograft used for 1-level anterior cervical discectomy and fusion

Krause¹,

Obayashi²,

Bridges³

et al. 2019

Journal of Neurosurgery: Spine

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OBJECTIVECommon interbody graft options for anterior cervical discectomy and fusion (ACDF) include structural allograft and polyetheretherketone (PEEK). PEEK has gained popularity due to its radiolucency and its elastic modulus, which is similar to that of bone. The authors sought to compare the rates of pseudarthrosis, a lack of solid bone growth across the disc space, and the need for revision surgery with the use of grafts made of allogenic bone versus PEEK.METHODSThe authors retrospectively reviewed 127 cases in which patients had undergone a 1-level ACDF followed by at least 1 year of radiographic follow-up. Data on age, sex, body mass index, tobacco use, pseudarthrosis, and the reoperation rate for pseudarthrosis were collected. These data were analyzed by performing a Pearson’s chi-square test.RESULTSOf 127 patients, 56 had received PEEK implants and 71 had received allografts. Forty-six of the PEEK implants (82%) were stand-alone devices. There were no significant differences between the 2 treatment groups with respect to patient age, sex, or body mass index. Twenty-nine (52%) of 56 patients with PEEK implants demonstrated radiographic evidence of pseudarthrosis, compared to 7 (10%) of 71 patients with structural allografts (p < 0.001, OR 9.82; 95% CI 3.836–25.139). Seven patients with PEEK implants required reoperation for pseudarthrosis, compared to 1 patient with an allograft (p = 0.01, OR 10.00; 95% CI 1.192–83.884). There was no significant difference in tobacco use between the PEEK and allograft groups (p = 0.586).CONCLUSIONSThe results of this study demonstrate that the use of PEEK devices in 1-level ACDF is associated with a significantly higher rate of radiographically demonstrated pseudarthrosis and need for revision surgery compared with the use of allografts. Surgeons should be aware of this when deciding on interbody graft options, and reimbursement policies should reflect these discrepancies.

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“…24 Cost-effectiveness also becomes an essential factor to be considered. The cost for PEEK-assisted one-level ACDFs is up to 30% higher compared to the same procedures utilizing allograft cages, 2,25,26 along with significantly higher surgeon professional fee reimbursement. 2…”

Section: Randomized Trialmentioning

confidence: 99%

Prospective, Randomized, Blinded Clinical Trial Comparing PEEK and Allograft Spacers in Patients Undergoing Anterior Cervical Discectomy and Fusion Surgeries

Villavicencio

Nelson

Rajpal

et al. 2022

Spine

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Study Design. Prospective, randomized, blinded clinical trial. Objective. To examine clinical and radiological outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF) surgeries randomized to receive either polyether-ether-ketone (PEEK) or structural bone allografts. Summary of Background Data. The biomechanical qualities as well as osteoconductive, osteogenic, and osteoinductive properties of various graft materials have been previously evaluated. There remain questions, however, as to whether there are any clinical and/or radiographic outcome differences in the selection of interbody graft types for ACDF. Methods. Patients undergoing one- to three-level ACDF with single anterior plate fixation were randomized (1:1 ratio) to receive either cortical allograft or PEEK interbody spacers. Radiographic and clinical outcomes were assessed at 3, 6, 12, and 24 months with an additional postoperative radiographic assessment. Results. A total of 120 patients were enrolled and randomized. Comparing clinical outcomes, no differences in arm or neck pain scores were noted; however, there was a statistically significant (≤0.041) improvement in SF-36 PCS scores for the allograft group at all follow-up time points and a tendency toward lower disability scores. Overall, evidence of radiographic fusion was achieved in 87 (91.6%) patients: five (10.2%) and three (6.5%) patients had pseudoarthrosis (P = 0.72) in the PEEK and allograft groups, respectively. At 24 months’ follow-up time, any cervical or segmental alignment restoration achieved with surgery was lost and no statistically significant changes were detected when all levels of surgery were included. Likewise, there were no statistically significant differences between the groups for anterior or posterior body height measurements at the 24 months’ follow-up. Approximately 20% of patients had anterior and posterior subsidence, all grade 0 regardless of the group assignment. Conclusion. Comparable radiographic outcomes were observed for patients undergoing one- to three-level PEEK versus allograft-assisted ACDF surgeries. Although MCID comparisons suggest that allograft and PEEK-treated patients have similar clinical outcomes, testing that incorporates the magnitude of the change suggests that there may be a statistically significant greater magnitude of improvement for the allograft group patients, but further studies with a larger sample size would be helpful to determine if a true effect exists.

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ISASS Policy Statement - Cervical Interbody

Cited by 4 publications

References 17 publications

PEEK interbody devices for multilevel anterior cervical discectomy and fusion: association with more than 6-fold higher rates of pseudarthrosis compared to structural allograft

PEEK interbody devices for multilevel anterior cervical discectomy and fusion: association with more than 6-fold higher rates of pseudarthrosis compared to structural allograft

Fivefold higher rate of pseudarthrosis with polyetheretherketone interbody device than with structural allograft used for 1-level anterior cervical discectomy and fusion

Prospective, Randomized, Blinded Clinical Trial Comparing PEEK and Allograft Spacers in Patients Undergoing Anterior Cervical Discectomy and Fusion Surgeries

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